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Having lump in breast, noticed red rash and having pain. Ultrasound revealed hematoma and fluid in breast. Treatment?

Mar 2013
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Practicing since : 1998
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I had a car accident on November 4th and among several serious injuries (rupture of mesenteric arterie, lung collapse, knee bruise and tear) I also had a bruise and lump in my left breast. An ultrasound was done in January revealing an hematoma and fluid in the breast. Nothing was prescribed. Now,seven months later I developed lots of pain in the same area of the breast, a red rash and the lump is still there. Gone for another ultrasound. They say I have an abcess and infection, They prescribed pain medication (hidrocodone). Have not heard if I should have antibiotic or some drainage of the lump. It hurts a lot. Ice helps. Is this XXXXXXX ? What should be the treatment.? Why this happenned?
Posted Wed, 19 Jun 2013 in Women's Health
Answered by Dr. Aarti Abraham 23 minutes later
Thanks for your query.
Breast abscess is caused by a bacterial infection. The most common type of bacteria involved in a breast abscess is Staphylococcus aureus. Bacteria enter through a scratch in the skin or a tear in the nipple.

A number of factors increase your risk of developing breast abscess. Not all people with these risk factors will develop a breast abscess.
Risk factors for breast abscess in women who are not breastfeeding include:
Being of child-bearing age
Being overweight
Having a history of previous breast abscess
Inflammatory breast cancer (a rare type of breast cancer)
Smoking or other tobacco product use
A previous traumatic injury to the breast tissue and pre existent hematoma is a good nurture ground for bacteria and could be the most possible cause in your case for development of an abscess.

If you are not breastfeeding, you may be able to lower your risk of breast abscess by:
Avoiding use of tobacco products
Maintaining a healthy weight
Preventing irritation or cracking of the breast skin and nipples

The most common symptoms of breast abscess include:
Breast engorgement (swelling)
Breast pain
Nipple discharge
Nipple tenderness
Swelling, warmth and redness of the breast tissue
Tender or enlarged lymph nodes in the armpit on the affected side

In women who are not breastfeeding, the presence of an abscess may be a symptom of new-onset diabetes or an uncommon type of inflammatory cancer. In rare cases an abscess can result in a body-wide infection (sepsis, a life-threatening bacterial blood infection) if the infection spreads to the bloodstream.

An abscess can generally be diagnosed based on your description of symptoms and a physical exam by your health care provider.
Your health care provider may choose to administer tests such as a white blood cell count (WBC). A WBC test will measure the extent of the body’s immune reaction.

Broad-spectrum antibiotic medications used to treat breast abscess include:
Cephalosporins, such as cefazolin (Cefazil) or cephalexin (Keflex)
Erythromycin (E-mycin, E.E.S.)
Penicillins, such as penicillin G potassium
Surgical drainage of the abscess may be required in addition to antibiotic therapy. During surgical drainage of a breast abscess, a small cut will be made in the lump. The pus inside the abscess will be broken up and washed away. Your health care provider may leave a small drain in the incision to release any additional pus. The incision will be protected with a bandage to keep the area clean and dry. Your incision may not be sewn closed in order to let it heal from the inside to the outside.
Many health care providers now offer ultrasound-guided abscess drainage. In this method, ultrasound imaging is used to pinpoint the location and depth of the abscess. A needle is then inserted into the abscess and the pus is drained, or aspirated, through the needle. Ultrasound-guided aspiration is considered less invasive than surgical drainage.

You can speed your recovery by:
Alternating between taking warm showers and applying a cold compress to the affected area
Applying a warm, moist compress to the affected area several times a day
Engaging in proper hygiene to keep skin healthy
Moisturizing nipples to prevent drying or cracking

If the abscess is in initial stages, your doctor would try to manage it by painkillers and anti inflammatory medication, switching over to antibiotics / drainage later if required.
All the best.
Feel free to discuss further.
Above answer was peer-reviewed by
Follow-up: Having lump in breast, noticed red rash and having pain. Ultrasound revealed hematoma and fluid in breast. Treatment? 37 minutes later
Thanks for your answer. One more question. Will the abscess disappear? How long will it take?. What about the pain? I just heard I will start some antibiotic.
I don't have a crack on my nipple so I still dont know how I got this. I eat well (no red meat or dairt), Is my immune system low? I think they will refer me to a surgeon too. Concerned that I also have this big scar on my belly(product of the surgery) Can I also develop an abscess around the scar?
Answered by Dr. Aarti Abraham 8 minutes later
Hi again.
Unfortunately I do not have the details of the abscess - the size, severity of infection etc.
SO I cannot say how long it would take.
If it responds to treatment, it would disappear within a week or two.
If it needs drainage, it would disappear immediately, and then the drainage site would heal within two weeks.
As I said, your antecedent history of breast trauma could predispose you to infection, as old collected blood ( in the hematoma and bruise ) is a good source for bacteria to thrive.
Whether your immunity is low depends on the tests. You can have a WBC count done and general health status evaluated, blood sugars etc done to see if you are diabetic or not.
Chances of abscess over the abdominal scar are very low, as the breast tissue is loose and more prone to abscess formation.
Above answer was peer-reviewed by
Follow-up: Having lump in breast, noticed red rash and having pain. Ultrasound revealed hematoma and fluid in breast. Treatment? 42 hours later
Thanks. I started taking Cephalexin 500 mg 2 capsules twice daily. This is my third day. No improvement, Lump and breast s still painful with red rash. The pain is severe (9-10) and the only relieve is ice pads. I don't want to take narcotic (hidrocodone plus acetaminophen) so I take tylenol or Ibuprofen or Aleve. Nothing helps. Is there a topical cream I coul use ?
My main concern is that the infection can get in the blood stream or in another area of the body . I also have a meniscus tear in my knee and my PT , yesterday did not want to do apply ultra sound to the affected are not to stimulate the blood . Is that possible? I will have an appointent with a surgeon on Tuesday, XXXXXXX 4. Could not get an early appointment. For additional information, my doctor never mentioned that I have diabetes. My blood test have been normal . I will ask to do a WBC count.
Answered by Dr. Aarti Abraham 41 minutes later
The doctor would mention you were diabetic if you were tested and found positive.
Please confirm about that.
If you are not responding to antibiotics, you might need to have a drainage.
The PT was right in not apply ultrasound as it might dissipate the infection. XXXXXXX 4 is fine enough, but if you have high grade fever before that, you should visit the ER.
There is no topical pain reliever for a breast abscess.
Please take the prescribed pain medication if the pain is unrelenting.
You CAN try hot compresses.
Above answer was peer-reviewed by
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